两种固定方式治疗踝关节旋前外旋型骨折合并下胫腓分离的疗效比较

Comparison efficacy of two fixation methods in the treatment of pronation-external rotation fracture combined with distal tibiofibular syndesmosis disruption

目的比较带锁髓内钉固定、锁定钢板固定联合纽扣钢板系统治疗踝关节旋前外旋型骨折合并下胫腓分离的疗效。方法将80例踝关节旋前外旋型骨折合并下胫腓分离患者根据内固定方式不同分为观察组(40例,采用带锁髓内钉固定联合纽扣钢板系统治疗)和对照组(40例,采用锁定钢板固定联合纽扣钢板系统治疗)。比较两组手术情况和末次随访时踝关节活动度,采用AOFAS踝-后足评分、足踝功能障碍指数(FADI)评分评估两组术后各时间段踝关节功能。结果患者均获得随访,时间10~15个月。手术时间、住院时间、骨折愈合时间、术后完全负重时间、术后并发症发生率两组比较差异均无统计学意义(P>0.05)。AOFAS踝-后足评分、FADI评分:两组术后6个月、末次随访时均高于术后3个月(P<0.05),且末次随访时均高于术后6个月(P<0.05);两组各时间点比较差异均无统计学意义(P>0.05)。末次随访时踝关节背伸、跖屈活动度两组比较差异均无统计学意义(P>0.05)。结论带锁髓内钉固定、锁定钢板固定联合纽扣钢板系统治疗踝关节旋前外旋型骨折合并下胫腓分离疗效确切,均具有固定牢靠、创伤小、术后并发症少、符合生物力学特征等优点。

Objective To compare the efficacy of interlocking intramedullary nail fixation,locking plate fixation combined with button plate system in the treatment of pronation-external rotation type fracture combined with distal tibiofibular syndesmosis disruption.Methods Eighty patients who suffered from pronation-external-rotational fracture combined with distal tibiofibular syndesmosis disruption,were divided into observation group(40 cases were treated with interlocking intramedullary nail fixation combined with button plate system)and control group(40 cases were treated by locking plate fixation combined button plate system).The operation status and ankle range of motion(ROM)at the last follow-up were compared between the two groups.At various time periods after surgery,AOFAS ankle-hindfoot score and the foot-ankle dysfunction index(FADI)score were used to evaluate the ankle function of two groups.Results All patients were followed up for 10~15 months.There were no significant differences in operation time,hospitalization time,fracture healing time,postoperative full weight-bearing time,and postoperative complication incidence rate between the two groups(P>0.05).AOFAS ankle-hindfoot scores and FADI scores:at 6 months postoperation and the last follow-up,which were higher than those at postoperative 3 months(P<0.05),and the data of two groups at the last follow-up were higher than those at 6 months posoperation(P<0.05);there were no differences between the two groups at various time points(P>0.05).At the last follow-up,there were no significant differences between the two groups in the ankle ROM with dorsal extension and plantar flexion(P>0.05).Conclusions In the treatment of the pronation-external rotation type fractures of ankle joint combined with disruption of distal tibiofibular syndesmosis,interlocking intramedullary nail fixation,locking plate fixation combined with button plate system have definite effect,which have firm fixation,less trauma,fewer postoperative complications,and conform to biomechanical characteristics.